The Fears You Don’t Face Keep Frightening You For An Eternity, Want A Short Cut?

I have learned of a legend in the Tibetan Book of the Dead by reading about it in Dr. David Burns’s book titled “When Panic Attacks,” (p. 251). Here is a short version of it:

Facing a Monster

According to this legend, you wake up in a dark place after you die. A scary monster appears from the dark that represents your worst fears. Facing this monster, you have the choice of surrendering to it, which is going to bring you the relief of defying it for good, or you may run away which gives you the momentary relief of the fear you are facing. But if you run away, out of the darkness comes another monster that requires you to make the same choices, surrender so you can find relief forever, or run away from it for now. Naturally, the option of running away will eventually wear you out, and you will feel defeated by the monster while remaining frightened for life. However, surrendering to it gives light to the fact that it was a toothless monster, that indeed it was only an illusion and that it might even turn out to be funny that you held such a strong conviction about it even being a scary monster in the first place.

Eradicating Anxieties and Fears

Learning from the wisdom of this legend, there is a very effective technique of eradicating anxieties and fears called the “Exposure Technique.” The trouble is that most people get mesmerized by the fear, say the fear of heights, and avoid going to high places because they don’t like to feel dizzy and anxious. Or in the case of shy people, they would avoid parties or people altogether, because they don’t like to feel insecure and inadequate. This avoidance unfortunately only fuels your fears however. In order to be relieved from the anxiety, you will need to get exposed to it, over and over, until it no longer triggers those uncomfortable feelings anymore.

Confront Your Fears
Exposure therapy can be done in several ways. One way is to literally confront your fears in a real form. For example, someone who fears getting sick and dying would purposefully shake hands with someone who has cold symptoms. They will then see in real life that even if they do catch the cold virus, at most they would feel under the weather for a few days, but they won’t indeed die.

Another form of Exposure Therapy is Cognitive Exposure. In this form you face your fears in your mind’s eye. You think and visualize the dreaded time or the dreaded experience, and you stay with it in your mind’s eye and maybe repeat to yourself a verse such as “I am not afraid of you” and you do this so many times until the fear finally goes away.

Repeated Exposure

Lastly, there is the Interpersonal Exposure technique. For example, in the case of someone with Social Phobia, they might have to actually go to a crowded place such a coffee shop, and scream: “I am shy.” They might have to stand a grand feeling of shame and humiliation at first, but repeated exposure to various social situations and indeed starting a conversation with people, will give the brain a chance to see that it needs not call the “fire department,” nothing bad is happening, so the fear will subside.

In short: Exposure Therapy is the short cut to what otherwise can be a lifetime of fearfulness and anxiety.


5 Tips to Keep Pain And Sadness At Bay During The Fall Season

If you are someone who can tell the weather is changing not by looking out the window, but by the way your mood feels or the way your body feels, then you know about the effects of season changes.

Some people are particularly sensitive to low levels of sunlight and react to overcast days by feeling blue. This condition is called Seasonal Affective Disorder or SAD. Moreover, people with chronic pain such as fibromyalgia, arthritis, or general muscle pain are often particularly sensitive to feelings of depression. In other words, depressive feelings make their pain worse. And when you have increased pain, you are likely to feel more depressed.

It’s like we are talking about a circular motion, where one condition makes the other worse and vice versa.

It does not really have to be this way. Here are some tips to keep this circular motion from starting off in the first place:

1-      Develop a conscious understanding about two links: A) the link between the weather and mood, B) the link between mood and pain. Be prepared; acknowledge within yourself that these links exist.

2-      Become good friends with the weatherman! Check the weather’s patterns and begin to learn the patterns of sunny hours or sunny spots. Then go out of your way to schedule an hour of being out in the sun on a daily basis, or at least 3 times a week.

3-      Ask yourself “what thoughts are just going through my mind.” Examples of negative thoughts that affect your mood and therefore your pain are: “I hate Fall and Winter, I just have to suffer through them.” Notice a strong element of All or Nothing Thinking in there. Instead, replace that thought with something like: “Although the overcast weather makes me feel down and my pain gets worse that way, but I will find sunny patches when I can allow the sun rays get absorbed in my body, then my body won’t have that negative reaction and I can get through the season without necessarily feeling worse.”

4-      Remain physically active. Even though the warmth of the summer days make the idea of being physically active more enticing, but you know that you owe it to yourself to give yourself the benefit of keeping your joints and your muscles active. Hibernating, staying in bed, resting more than what your actual rest times are will backfire. Look into going for a walk, sign up for some gentle swimming, see about taking up Pilates or yoga or both. You’ll be doing your pain condition and your mood a lot of good this way.

5-      Talk openly about your condition and ask for help. There is no shame or stigma on how you are genetically formed. So, your brain reacts to overcast conditions. That is the same as indicating the color of your eyes. Let people know how you are planning on taking charge of your needs by scheduling “sun times” and by maintaining a positive attitude about the whole thing and by scheduling physical activities.

I am Dr. Katie Dashtban. As a Health Psychologist, one of my jobs is to help people make attitudinal and behavioral changes that help them in coping ideally with their medical conditions.

Call me or write to me with any questions: 831-621-1150 or 510-400-6160.

Published in: on September 12, 2012 at 12:39 pm  Leave a Comment  

When tempted for food…

When tempted for food, is it easier to eat and be done with the temptation or not eat and be done with the temptation?


If you are a foodie or just find it too tempting to do away with high calorie foods then you have probably experienced the pain of being tempted, not wanting to give in to it, and then finally giving into it.

Emotions such as guilt, disappointment, sadness and even anger are common when people give into their temptations. Similarly, sadness, feeling lonely, and rejected are commonly experienced when one does not give in to temptation. So it is almost a double aged sword, you get hurt whether you give in or not. Right? ..Not so right!!

Human mind has a strong tendency for wanting to be sure and knowing exactly what to do. That “in between” feeling is what drives most people bunkers. It is called Cognitive Dissonance, or in plain English, the pain of being in a limbo.

Here is the break down of Cognitive Dissonance when facing a food temptation: At first you are not thinking of the food, then suddenly you sense its smell, see its sight, or just imagine its texture in your mouth. You think to yourself how lovely it would be to have it. Then right away, you think of all the reasons why you should not have it, “its too heavy, it’ll throw you off your weight loss plan, it’ll take so much time to burn it off, etc.” It is in that moment of indecisiveness or being pulled to two different yet equally strong points of view that you experience anxiety, sadness, guilt, loneliness, feeling rejected, etc. These negative emotions are associated with that cognitive dissonance or that state of being in a limbo. So taking the food or not taking the food are not the real causes of negative emotions, being in a state of cognitive dissonance is the cause of those negative emotions.

So what to do:

Deciding not to take the tempted food and willfully walk away (literally or mentally) from the food will help you out of that limbo state, back into a state of knowing what is ahead. Once you are in that state of knowing what is ahead, then the pain of temptation is gone and you are once again able to be back to where you were in the beginning: all fine and care-free.

For more information regarding this article or related topics visit or write to Dr. Dashtban at

Published in: on May 23, 2012 at 6:52 pm  Leave a Comment  

Spinal Cord Stimulator

When it comes to successful management of chronic back pain, sometimes extreme measures such as surgery on the spinal cord is necessary. In this type of surgery a device is used to exert pulsed electrical signals to the spinal cord to control chronic pain.

Often patients are asked to obtain a psychological evaluation before the surgery can be offered. The purpose of the psychological evaluation is to assure that patients’ mental and emotional health as well as their beliefs regarding successful pain management are predictive of successful outcome after surgery. In other words, surgeons and often insurers would like to offer the surgery to candidates that seem likely to highly benefit from it, otherwise the risks may outweigh the benefits. 

For more information on psychological evaluation for SCS  visit

Published in: on March 12, 2012 at 12:23 am  Leave a Comment  

Is there a difference between disease and illness?

In my practice as a medical psychologist, I have noticed that when a person experiences undesirable symptoms, for example pain, that there is often a distinction between what their physician calls a disease versus what the patient calls her illness.  In other words, there is often a distinction made between disease and illness.

Clinical experience has shown that people categorize their ideas about an illness around 5 themes:

  1. Identity  that is how do you see yourself now that you have this illness, for example do you say I am hypertensive, meaning I have high blood pressure, or do you say I watch how much salt I take because my blood pressure seems to go too high when I take up too much salt.
  2. 2.      Cause What do you think has caused your illness? Sometimes lifestyle choices do lead to some diseases, sometimes a disease happens on its own. So what is your belief system about what caused your illness.
  3. 3.      Timeline How long do you think your illness will continue? For example, do you think this is going to last a week, or do you suspect this is going to stay with you for a lifetime, or somewhere in between.
  4. Consequences  How much does your illness affect your life? For example, now that you have this disease, in what ways has your life been affected by it?
  5. Cure or Control how much do you think your treatments can help your illness or how much control do you feel you have over your illness?

So once these 5 themes have been addressed, then you have a much better understanding of what your illness is, regardless of what the disease is all about.  This means you might have a much better chance of going about treating your illness in a far more effective way. In other words, you will have the chance to do, what is called  Self Management.

Self Management  is the capacity of a patient to take appropriate responsibility for dealing with all aspects of their illness including the symptoms, the treatments, physical and social consequences and lifestyle changes.

As a medical psychologist, my job is to help people self manage their illness. For example,  patients can learn how to monitor their condition and how to make whatever changes in their thought patterns, their behaviors and their emotions so that they can notice a satisfactory quality of life.

For help on best ways to self-manage your health and or the course of your illness, please contact me at or 831-621-1150

Warm regards,

G. Katie Dashtban, Psy.D. Licensed Clinical Health Psychologist, PSY22256

Published in: on September 15, 2011 at 9:04 pm  Leave a Comment  

Taking ownership of pain, a blessing not a curse

When it comes to chronic pain, the matter has clearly been bothering you for a while. You have been coping with pain for at least 6 months, sometimes even years.  It is very likely that you feel sad, anxious and maybe even angry for the disruption that pain has brought into your life.

At this point, it might look like it is somebody’s fault that this is not going away. You might be blaming your physicians for not having had successfully been able to cure the pain, or maybe even blame your family members  and loved ones for not doing anything to help you, or because of not showing an understanding or empathy about  your problem.  You may even find the society and your job to blame for causing the situation that put you in pain in the first place,  and for not  making it easier for you to seek help.

It is tempting to feel that others are to blame for the pain and that it is their responsibility for taking it away. People often put their lives on hold while they are waiting for doctors, family members, even society at large to do something.  

There is one major problem with this way of thinking and that is it only prolongs your sense of powerlessness. It makes you feel out of control and at the mercy of others. It sometimes even leads to distortions in thoughts such as: “nobody cares how much I am hurting, or no one can do anything for me, I am all alone in this.”

It turns out that when you take ownership of your own pain , suddenly this feeling of powerlessness can turn into a feeling of being in power, being in charge of things.  But now you might  be thinking: so I’m responsible for my pain, I am the one to blame? And that is precisely what Is not being implied by taking up ownership of your pain. As you know, self blame, guilt and anger can be paralyzing emotions, they can make you feel so out of sorts, so hopeless that there would seem to be no point in doing anything at all. Taking ownership of your pain means acknowledging that you are a worthwhile person, that there is a point in doing something, and that you do have choices. It is very different than blaming yourself.

By taking ownership of the pain, you get to be the captain of the ship, the one that makes all the decisions about your lifestyle, how much and what kind, you are the boss of your body and in charge of your health.

For more information on managing chronic pain successfully, write or call me at or 831-621-1150.

Have a blissful moment.

Published in: on September 15, 2011 at 8:58 pm  Leave a Comment  

Reading in bed

From the time we are infants, we are “put to bed” with some type of soothing ritual, ie. lullaby or being rocked. It seems natural to acquire a bed time routine in order to reach for a good night sleep. So, yes, reading a light book that is not too emotionally activating is often what helps people reach that desired drowsiness that transfers them into sleep. I hear often that reading poetry is a fabulous way to end your awake hours. It is much better to allow your body to naturally fall asleep as opposed to being exhausted to sleep such as by watching TV or by tossing and turning.

I am Dr. Dashtban. Write to me with questions about health and habits to

Published in: on August 2, 2011 at 9:54 pm  Leave a Comment  

Metabolic Syndrome, Complicated With Mental Illness


Metabolic syndrome, complicated with mental illness

Metabolic syndrome nearly affects 50 million people in America. Anyone with 3 or more of the following attributes is most likely affected by metabolic syndrome:

  • Women: waist size of 35 inches or more, men: waist size of 40 or more.
  • Blood pressure of 130/85 mm Hg or higher.
  • Good cholesterol (HDL) of less than 40 mg/dL in men, and less than 50 mg/dL in women.
  • High fat in the blood – triglycerides of 150 mg/dL or higher.
  • High blood sugar, a fasting level of 100 mg/dL or higher.

People with mental illnesses such as bipolar disorder or clinical depression are especially vulnerable. This vulnerability is partially due to medications prescribed for the treatment of mental illnesses, but it is also because of smoking, inadequate nutrition, lack of exercise, and limited access to quality health care. Most people with mood disorders such as depression and bipolarism report that it is difficult for them to get going with exercise, to stay quite from smoking, or to not eat comfort foods such as sugary and starchy foods. Such health habits lead to weight gain, which in turn can domino into insulin resistance, – a condition in which the body cannot use insulin (the main hormone that enables cells to convert blood sugar  into energy). As insulin resistance gets worse over time, it takes a toll on the pancreas which then leads to chronically high blood sugar levels. That can cause diabetes which is one of the main risk factors of heart disease.

What to do?

3 ways to keep metabolic syndrome worsening to heart disease .

1- If you’ve been prescribed antipsychotic medications, ask your doctor to give you antipsychotic medications that are least likely to increase risk of metabolic syndrome such as Geodon or Abilify.

2- Monitor the risk factors such as your weight, waist circumference, blood sugar, cholesterol and triglyceride levels, and blood pressure. You can do some of this on your own such as weighing yourself on a scale at home once a week, using a tape measure and a piece of paper to log your waist circumference on it once a month. You can also buy an over the counter blood pressure machine, and maybe even a diabetes kit which is aimed to measure the blood sugars. For the cholesterol and triglyceride levels you’d need your doctor’s help, ask them to help you monitor those by writing a lab order and having those levels checked twice a year.

3- In terms of eating nutritious food, taking up exercising and quitting smoking, you can either use a variety of self help materials such as books, tapes, gyms, a good friend etc. For some people, going to a health psychologist proves to be an amazing investment because often underlying emotions, unaddressed needs, and insight into how to advocate for your own health is needed to secure success in maintaining these health habits.

I am Dr. Dashtban. Write to me with your questions about health and habits to

Published in: on August 2, 2011 at 9:47 pm  Leave a Comment  

Why consider visiting a pain psychologist when you have back pain

Almost anyone is likely to experience back pain at some point in life. However, some sufferers of chronic back pain who have not found medications and surgeries too helpful are likely to suffer emotionally as well. These patients find it hard to go to places with their families, they can’t enjoy the occasion as much as everyone else seems to enjoy. They often report not being able to work the regular 8-hour day jobs; some can’t even work at all. They say their sleep has turned into one strenuous ordeal and they also say they are not as happy and satisfied with their romantic relationships. On top of all this, they take pain medications that often leave them feeling groggy, sleepy, and unable to concentrate, they notice various negative side effects from those medications. That’s the time to refer to a licensed pain psychologist (other names of this specialty are: Medical Psychologist, Health Psychologist, and Behavioral Medicine Specialists) who understands pain both from physiological and psychological perspectives. A pain psychologist can help in figuring out how to get back to enjoying life with friends, how to pace your daily activities to where you don’t over do or under do it. Pain psychologists can help in sorting out depressive feelings that arise because of being in pain, how to find a way to enjoy your romantic relationships once again and how to find a way to work and feel productive again. Pain psychologists can also help in sorting out your medications and figuring out the best ways to get the most mileage out of your pain medicine. Prescribing physicians often are happy to refer their pain patients to a trained pain psychologist. This is because it really takes both the care of a physician and the care of a pain psychologist to manage the pain and keep it from getting worse. If you are a chronic pain sufferer, ask your physician about being referred to a pain psychologist.

This is Dr. Dashtban. write your questions regarding health and habits to me directly at

Published in: on August 2, 2011 at 8:49 pm  Comments (1)  

What is your pain fear number?

Most people are familiar with the pain scale. It is a subjective way of measuring one’s pain level at a given moment. There is no medical device or medical test that can objectively measure one’s pain level and so health care providers rely on the patients’ own report. The pain scale asks patients to rate their pain level somewhere between 0 (no pain at all) to 10 (the worst pain you can imagine). But it is not unusual for patients to feel frustrated when asked to rate their pain level on this scale. Patients sometimes report numbers higher than 10 on a scale that has a maximum level of 10. Why is that?

It turns out that pain is often anxiety provoking and sometimes down-right scary. Even most health specialists, when faced with high levels of pain, wonder if the pain will ever go away and if they will ever be all right again. The fear of staying in that much pain, the fear of  body parts being damaged or at least loss of function at that part can begin to feel so real and so threatening. So when asked by health care providers what their number on the pain scale is, patients are reporting their fear number as well as their actual pain number, and that leaves little wonder as to why a maximum of 10 is not enough to capture what their true experience is.

There is no magical way to foresee what exact message pain has. While translating the exact message of pain can be tricky, pain should be taken seriously because it is always the body’s way of saying something to us.  It is perhaps most helpful to trust that once medical work ups have been done and a “no threat” bill of health has been issued by the treating physician, then the fear level be tested separately from the pain level. The fear level often stems from catastrophic thoughts, images of being disabled, seriously harmed. While being on the lookout and perhaps a bit pessimistic can sometimes save future disasters, but often such thoughts prove to be debilitating. At times like this a bit of reality check can save a lot and be very useful.

Ask yourself questions like:

1)      Am I fearful of my pain because it resembles the pain of a relative or friend which ended up being disastrous?

2)      Are my treating physicians concerned that the higher my pain the more damage I am receiving which will lead to further disability?

3)      As difficult it is to deal with it, am I actually going to die from this pain?

4)      Can I just concentrate on this hour and not think of how I am going to live the rest of my life?

 So, what is your fear number?

Call or write to me at 831-621-1150 or

Published in: on February 21, 2011 at 11:08 am  Leave a Comment  
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